Abstract
The last years of research have proposed that bacteria might be involved in and contribute to the lack of healing of chronic wounds. Especially it seems that Pseudomonas aeruginosa play a crucial role in the healing. At Copenhagen Wound Healing Centre it was for many years clinical suspected that once chronic venous leg ulcers were colonized (weeks or months preoperatively) by P. aeruginosa, the success rate of skin grafting deteriorated despite aggressive treatment. To investigate this, a retrospective study was performed on the clinical outcome of 82 consecutive patients with chronic venous leg ulcers on 91 extremities, from the 1st of March 2005 until the 31st of August 2006. This was achieved by analysing the microbiology, demographic data, smoking and drinking habits, diabetes, renal impairment, co-morbidities, approximated size and age of the wounds, immunosuppressive treatment and complicating factors on the clinical outcome of each patient. The results were evaluated using a Student T-test for continuous parameters, chi-square test for categorical parameters and a logistic regression analysis to predict healing after 12 weeks. The analysis revealed that only 33,3% of ulcers with P. aeruginosa, isolated at least once from 12 weeks prior, to or during surgery, were healed (98% or more) by week 12 follow-up, while 73,1% of ulcers without P. aeruginosa were so by the same time (p = 0,001). Smoking also significantly suppressed the outcome at the 12-week follow-up. Subsequently, a logistic regression analysis was carried out leaving P. aeruginosa as the only predictor left in the model (p = 0,001). This study supports our hypothesis that P. aeruginosa in chronic venous leg ulcers, despite treatment, has considerable impact on partial take or rejection of split-thickness skin grafts.
Highlights
In Denmark, it has been estimated that the prevalence of nonhealing wounds is about 1% of the population
Patients A retrospective study was conducted of consecutive patients who underwent meshed split-thickness skin grafting for chronic venous leg ulcers in Copenhagen Wound Healing Centre, Bispebjerg Hospital, Denmark, over a period of 18 months from the 1st of March 2005 until the 31st of August 2006
Skin graft loss due to infection make up only a minor part in the literature with very few publications on deterioration of skin grafts due to P. aeruginosa [8,12,13,14,15,16], in the field of chronic lower limb ulcerations
Summary
In Denmark, it has been estimated that the prevalence of nonhealing wounds is about 1% of the population. The prevalence and incidence of leg ulcers are similar to elsewhere in the industrialized world[1]. Meshed Split Thickness Skin Grafts (STSGs) are widely used in the treatment of non-healing leg ulcers. A limited number of publications on skin graft loss due to infection exist and they are mostly related to the management of burn wounds. The majority of publications discussing qualitative bacteriology point out haemolytic streptococci in particular Streptococcus pyogenes as the predominant species leading to graft lysis[6,7,8,9,10]. Graft lysis due to non-group A beta-haemolytic streptococci has been reported[11] together with Staphylococcus aureus [12] and Pseudomonas aeruginosa[8,12,13,14,15,16]
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